OPHTE# l0-5-7;*-Xt Harnett County Department of Public Health 21 4 6 6
PERMIT # dC7 Operation Permit
New Installation , I Septic Tank El RepairX Nitrification Line ❑ Expansion
PROPERTY LOCATION: ASX~C;Y- ZQ
Name: (owner) Ysvr., na tIIRf11VKl(1N P%n.,sGCn c Inr
System Installer: V-P-4 y-j ~>v Registration #
Basement with plumbing: ❑ Garage ❑ Number of Bedrooms 3
Type of Water Supply: ❑ Community 'X Public ❑ Well Distance from well 100 feet
System Type: 71(12 Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
Ihis system has been installed in compliance with applicable North Carolina General Statutes, Rules for Sewage Treatment and Disposal, and all conditions of the Improvement Permit and Construction Authorization
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1. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
III. Maintenance: As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ Nox
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other.
Following are the specifications for the sewage disposal system on the above captioned property.
Type of system: ~ Conventional El Other
Subsurface No. of exact length
Drainage Field ditches of each ditch 115 feet
French Drain Required: Linmfeet
Septic Tank: En(NO gallons Pump Tank: gallons
width of depth of
ditches 3 feet ditches a inches
Authorized State Agent qja"5 Date 51 U-1 LO